Faculty Coding, Billing & Reimbursement Compliance Auditor - Office of Institutional Compliance

UTMB Health•Galveston, TX

60d•Onsite

About The Position

This position utilizes advanced skills to audit the documentation, coding, and reimbursement of professional, hospital/facility inpatient and outpatient billing. The auditor will ensure that documentation is complete and accurately reflects and supports the coded level of service. Audits will determine if the billed services are consistent with medical record documentation and in accordance with appropriate third-party billing regulations and/or standards. The role also assists with the development and implementation of pre- and post-audit education as needed.

Requirements

Bachelor’s degree or equivalent and at least four years of relevant experience.
Certified Coding Specialist (CCS) by the American Health Information Management Association (AHIMA) required.

Responsibilities

Utilizes auditing software to select and conduct random or focused audits of professional and hospital/facility inpatient and outpatient billing based on determined criteria.
Conducts prospective and retrospective professional and inpatient and outpatient documentation audits to confirm compliance with documentation and billing rules and regulations set forth by the Centers for Medicare and Medicaid Services (CMS), Medicare/Medicaid Administrative Contractors (MACs), Medicare/Medicaid Recovery Audit Contractors (RACs), governmental audit entities, State regulations, and Institutional policies.
Applies knowledge of professional, inpatient, and outpatient coding guidelines, and clinical documentation requirements to review billed services.
Maintains a thorough understanding of CPT, ICD-10-CM, ICD-10-PCS, DRG, and HCPCS coding principles, governmental regulations, work plans, and third-party guidelines regarding documentation and/or billing compliance.
Develops and maintains a close working relationship with the Billing Compliance team to ensure documentation issues, patterns, and/or trends are identified and addressed by prospective compliance education in a timely manner.
Reviews providers’ and coding personnel’s coding accuracy and determines if the medical record is properly documented and if documentation supports the services billed.
Performs Quality Assurance (QA) reviews of other auditors within the Office of Institutional Compliance as required.
Assists with analysis of data/reports from compliance monitoring activities to help identify trends, issues, risk areas, and opportunities for education and/or process improvement.
Prepares and presents reports as needed.
Monitors compliance with documentation standards and keeps current with changes in coding guidelines, compliance, reimbursement, and other regulatory updates; researches, investigates, evaluates, and identifies opportunities for improvement.
Has a good understanding of all clinical information systems and data flow across the continuum of care.
Completes other job-related functions and special projects as assigned by the director.
Performs other duties as required.